So many blank spots on the clinical data map!

EMTs collect a lot of data on their trip to the emergency department — and usually, data treating ED physicians will want pretty badly when they see the patient. But in virtually every case, most of that critical info transfer takes place on paper or in a hurried conversation amidst much noise and distraction.

Community medical centers collect as much data on patients as private primary care practices do, but how often are they connected with hospitals — even those that have done a big ambulatory EMR rollout?

And what about blood banks? Independent clinical labs like LabCorp.? School medical offices? Is anyone paying attention to their data, or is it just being ignored?

Look, I don’t mean to be a dunce here. It’s not as though hospitals and medical practices are sitting around buffing their nails and waiting for something to happen, data-connection wise.

But it’s worth remembering, despite the labor involved in hooking up hospitals and primary care practices, that there are data leakage everywhere. Until we look the flow of data more wholistically, whole workflows will be designed as though such relationships didn’t even exist — and that’s a Bad Thing.

I say, start with the EMT data, as it’s the closest to the point of care, but regardless of how you expand your clinical data source map, expand it. Otherwise, you’ll be left with a nasty information design problem and finding a workaround will be a nighmare. Think about it.

(This editorial’s content draws on a speech given by Vivian Funkhouser of Motorola at a trade show held last week by Everything Channel.)

One response to “So many blank spots on the clinical data map!”

Good points– a few years ago my wife had a major seizure — her first and at post 50. Needless to say I was totally freaked, as was our niece also sitting at the table. It was in Carlsbad, CA– the EMT team was absolutely incredible– their training, experience, and knowledge really impressed me, and that’s not easy particularly when dealing with a loved one.

The hospital is also exceptional– we have a family member there this week in fact receiving exceptional care. The one exception to this experience– actually two– first was that most of the data had to be delivered to the hospital from the field and in route by voice, and then it was difficult, timely, and expensive (labor wise) accessing the data–including her board certified neurologist later– there is no excuse for this today. The second issue, which had nothing to do with the team, was the expense– $10,000 in a couple of hours, and that did not include extensive testing that came later. For the services received in careful review it appears about 40-50% higher than it should have been, perhaps half of which is due to others not willing or able to pay– not a terribly well aligned gotcha system, particularly given that it is an absolute monopoly– we would have selected the same people and orgs if we had the knowledge and choice, but didn’t.

The one mistake made during this one experience was that the generalist in the ER prescribed an extremely powerful drug–(potentially dangerous) in his own words to be on the safe side. A neurologist was on call–if the data were available at a glance remotely to an experienced specialist, as was the case a few days later, a more appropriate drug and dosage would have been prescribed.

While one case does not make a trend, these are common issues even in the best organizations. We need the same focus, passion, and professionalism dedicated to the organizational and computer systems as I witnessed that day with the EMTs and emergency team. There is not much comparison between the human and organizational systems– the gap is huge, but it affects outcomes just the same.